Anger Episodes Research Articles

A Randomised Study of Triggered Acute Risk Prevention (TARP) for Risk Reduction

Background: Prior studies have shown that acute cardiovascular disease (CVD) may be triggered by external stressors; however, it remains uncertain how to use this information for disease prevention. Aim: To determine, using a randomised controlled study design, whether it is feasible for individuals with ≥2 risk factors or known CVD, to take targeted medication using customised packaging for specific stressors. Assessments include haemodynamics, lipids and inflammatory markers, and questionnaires of self-mastery and quality of life. Methods: Subjects initially recorded episodes of heavy physical exertion, anger and anxiety, heavy meals and respiratory infection over 2 weeks. After baseline measures and questionnaires were obtained, subjects were randomised to control (usual therapy) or a treatment strategy for 4 months, during which they were additionally instructed to take either aspirin 100 mg and propranolol 10 mg (for episodes of significant physical and emotional stress), or aspirin alone (for respiratory infection and heavy meal). Results: In this ongoing study, 20 subjects have completed the protocol. Using Likert scales, subjects randomised to treatment reported that the medication packaging was convenient, and they were confident in taking the medication and sustaining the strategy into the future. Feedback included a greater insight into their health and improved dealing with anxiety and anger. Ongoing subject enrolment will enable evaluation of other study endpoints. Conclusions: Initial data suggest that it is feasible to conduct a randomised-controlled trial for individuals at increased CVD risk to identify potential triggers of acute CVD and take targeted medication at the time of these triggers.

Associations between bride price obligations and women's anger, symptoms of mental distress, poverty, spouse and family conflict and preoccupations with injustice in conflict-affected Timor-Leste

ObjectivesBride price is a widespread custom in many parts of the world, including in most countries in sub-Saharan Africa and parts of Asia. We hypothesised that problems relating to the...

What Triggers Anger in Everyday Life? Links to the Intensity, Control, and Regulation of These Emotions, and Personality Traits.

Why do people experience anger? Most of our knowledge on anger-triggering events is based on the study of reactions at a single time point in a person's life. Little research has examined how people experience anger in their daily life over time. In this study, we conducted a comprehensive examination of the situational determinants of anger over the course of 3 weeks. Using daily diary methodology, people (N = 173; 2,342 anger episodes) reported their most intense daily anger and, with an open-ended format, described the trigger. Participants also answered questions on anger intensity, control, and regulatory strategies, along with baseline personality trait measures. Using an iterative coding system, five anger trigger categories emerged: other people, psychological and physical distress, intrapersonal demands, environment, and diffuse/undifferentiated/unknown. Compared with other triggers, when anger was provoked by other people or when the source was unknown, there was a stronger positive association with anger intensity and lack of control. Personality traits (i.e., anger, mindfulness, psychological need satisfaction, the Big Five) showed few links to the experience and regulation of daily anger. Although aversive events often spur anger, the correlates and consequences of anger differ depending on the source of aversion; personality traits offer minimal value in predicting anger in daily life.

El enojo como rasgo de personalidad y agresión física en adolescentes de preparatoria

La presente investigación comparó a jóvenes de preparatoria (M de edad = 15.92, DE = 0.9) con alto y bajo enojo rasgo con respecto a cuándo, dónde y hacia quién mostraron su enojo por medios físico- agresivos (e. g., golpear a alguien, dañar objetos). Los grupos de alto y bajo enojo rasgo quedaron definidos por la pertenencia de sus integrantes al cuartil superior (alto enojo, n = 125) e inferior (bajo enojo, n = 149) en la Escala de Enojo Rasgo (Moscoso & Spielberger, 1999). Dicha escala midió el patrón o tendencia de los adolescentes a molestarse en cualquier lugar y con cualquier persona. Como resultado, a diferencia de los jóvenes con bajo enojo, los de alto enojo: 1) mostraron su molestia con agresiones físicas, recientemente, hacia otras personas (e. g., empujar a alguien) y el ambiente (e. g., golpear la pared); 2) aventaron cosas a sus hermanos/as durante el último mes, la última semana e incluso hoy; y 3) azotaron la puerta estando enojados en la mañana, en la tarde y en la noche, cuando estuvieron en casa. Los datos indican que las relaciones de los adolescentes con personas cercanas (hermanos/as) y sus propias casas fueron el contexto donde los episodios de enojo con agresiones físicas surgieron en mayor medida, especialmente en los jóvenes con alto enojo rasgo.

Prevalence and correlates of explosive anger among pregnant and post-partum women in post-conflict Timor-Leste.

BackgroundLittle is known about explosive anger as a response pattern among pregnant and post-partum women in conflict-affected societies.AimsTo investigate the prevalence and correlates of explosive anger among this population in Timor-Leste.MethodWe assessed traumatic events, intimate partner violence, an index of adversity, explosive anger, psychological distress and post-traumatic stress disorder among 427 women (257 in the second trimester of pregnancy, 170 who were 3–6 months post-partum) residing in two districts of Timor-Leste (response >99%).ResultsTwo-fifths (43.6%) had explosive anger. Levels of functional impairment were related to frequency of explosive anger episodes. Explosive anger was associated with age (>35 years), being married, low levels of education, being employed, traumatic event count, ongoing adversity and intimate partner violence.ConclusionsA combination of social programmes and novel psychological therapies may assist in reducing severe anger among pregnant and post-partum women in conflict-affected countries such as Timor-Leste.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Triggering of acute coronary occlusion by episodes of anger.

The aim of this study was to report the association between episodes of anger and acute myocardial infarction (MI) in patients with angiographically confirmed coronary occlusion. 313 participants with acute coronary occlusion (Thrombolysis In Myocardial Infarction 0 or 1 at emergency angiography) reported frequency of anger episodes in the 48 h prior to MI. In primary analysis, anger exposures within 2 h and 2-4 h prior to symptom onset were compared with subjects' own usual yearly exposure to anger using case-crossover methodology. Anger level ≥5 (on an anger scale of 1-7) was reported by seven (2.2%) participants within 2 h of MI. Compared with usual frequency, the relative risk of onset of MI symptoms occurring within 2 h of anger level ≥5 (defined as very angry) was 8.5 (95% confidence interval 4.1-17.6). Anger level <5 was not associated with onset of MI symptoms. Compared with 24-26 h pre MI, anxiety scores >75th percentile on State-Trait Personality Inventory were associated with a relative risk of 2.0 (95% confidence interval 1.1-3.8) and in those above the 90th percentile, the relative risk of MI symptom onset was 9.5 (95% confidence interval 2.2-40.8). Findings confirm that episodes of intense anger, defined as being 'very angry, body tense, clenching fists or teeth' (within 2 h) are associated with increased relative risk for acute coronary occlusion. Additionally, increased anxiety was associated with coronary occlusion. Further study, including the role of potential modifiers, may provide insight into prevention of MI during acute emotional episodes.

Exploring the blood volume amplitude and pulse transit time during anger recall in patients with coronary artery disease

Background and purposeOne psychopathological mechanism that links anger to coronary artery disease (CAD) is cardiac autonomic imbalance. Blood volume amplitude (BVA) and pulse transit time (PTT) are related to peripheral arterial elasticity and cardiac conduction, which are used as indirect markers for autonomic activation. The purposes of this study were to examine the relationships between BVA and PTT, and the reactivity of BVA and PTT during the anger recall task in patients with CAD. Methods and subjectsA total of 112 patients with CAD and 93 healthy controls were recruited; BVA and PTT were collected during baseline, the neutral episode, the anger episode, and after recovery. ResultsThere were significant positive correlations between BVA and PTT in all participants. BVA reactivity during the anger episode was greater in patients with CAD than in healthy controls, and there were also lower BVA recovery values after the neutral and anger episodes. However, there was no significant difference in BVA reactivity between the two groups in the neutral episode. PTT recovered to baseline levels after the neutral and anger episodes in healthy controls, but not in the patients with CAD. ConclusionBVA and PTT were associated with peripheral vascular elasticity and cardiac conduction that were regulated by the cardiac autonomic system. Peripheral vasoconstriction and changes in travel time between left ventricular and peripheral vasculature during the anger episode, and impaired recovery to baseline levels may relate to the psychopathological mechanisms of CAD.

Intensity and Duration of Negative Emotions: Comparing the Role of Appraisals and Regulation Strategies

Intensity and duration are two central characteristics of an emotional response. Appraisals and regulation strategies are among the most important determinants of these emotion features. However, as intensity and duration are only moderately correlated, appraisals and regulation strategies may be differently related to these characteristics. A systematic empirical study comparing predictors of emotion intensity and duration is missing. The goal of the present study is to fill this gap. Participants were asked to recall recently experienced episodes of anger, fear, disgust, guilt, sadness, and shame. Subsequently, they were asked to answer a number of questions regarding (a) the intensity and duration of these emotions, (b) their appraisal of the emotion-eliciting event, and (c) their use of a wide range of regulation strategies. Emotion intensity was found to be mainly predicted by appraisals whereas emotion duration was equally well predicted by appraisals and regulation strategies.

Abstract P288: Exposure To Psychological And Physical Challenges Immediately Prior To Myocardial Infarction And Increased 10-year Mortality

Objective: To examine the association between exposure to psychological (anger, anxiety) and physical (high activity levels, coffee consumption) challenge immediately prior to myocardial infarction (MI) as risk indicator of mortality at 10-year follow-up. Methods: Participants of the Determinants of Myocardial Infarction Onset Study (N=2176, mean age 60.1±12.5 yrs, 29.2% women) were interviewed to assess exposure to several potential triggers immediately prior to MI, including anger, anxiety, physical activity and coffee. All-cause mortality was assessed using the National Death Index for 10 years follow-up. We constructed Cox proportional hazards models with 95% confidence intervals to examine the relationship between exposure to these potential triggers in the 2 hours prior to MI onset and the rate of all-cause mortality, adjusting for demographic and clinical characteristics. Results: Exposure to anger, anxiety, physical activity or coffee consumption prior to MI was associated with a 30% higher mortality rate over 10 years (HR=1.30, 95%CI=1.06-1.59, p =0.011) compared to patients who were not exposed to any of these potential triggers. This association was stronger for the first 3 years of follow-up (HR=1.59, 95%CI=1.16-2.19, p =0.004) and weaker for years 3 to 10 (HR=1.14, 95%CI=0.88-1.48, p =0.32). In separate analyses for each exposure, there was a higher mortality rate associated with anxiety (HR=1.44, 95%CI=1.09-1.91, p =0.010) and a suggestion of a higher rate for anger (HR=1.33, 95%CI=0.97-1.81, p =0.075), but no association for physical activity or coffee consumption. Sensitivity analyses showed stronger associations for women than men, and patients aged 65 and older compared to younger patients. Discussion: MI following episodes of anger, anxiety, physical activity or coffee consumption is associated with higher all-cause mortality in the following 10 years. This association was strongest for anxiety and slightly lower for anger but there was no evidence of a higher mortality rate among MI patients reporting physical activity or coffee consumption immediately prior to MI.

Variability in anger intensity profiles: Structure and predictive basis

The aim of this study is to describe variability in the shape and amplitude of intensity profiles of anger episodes and how it relates to duration, and to investigate whether this variability can be predicted on the basis of appraisals and emotion regulation strategies used. Participants were asked to report on a wide range of recollected anger episodes. By means of K-spectral centroid clustering, two prototypical shapes of anger intensity profiles were identified: early- and late-blooming episodes. Early-blooming episodes are relatively short and reach their peak immediately. These profiles are associated with low-importance events and adaptive regulation. Late-blooming episodes last longer and reach their peak (relatively) late in the episode. These profiles are related to high-importance events and maladaptive regulation. For both early- and late-blooming profiles, overall amplitude is positively associated with event importance and the use of maladaptive regulation strategies and negatively with the use of adaptive ones.

Cardiac vagal tone predicts socially adaptive anger regulation

Cardiac vagal tone (CVT; i.e., the influence of the cardioinhibitory vagal pathway on the heart) is associated with individual differences in processes related to self-regulation. The presentation focuses on the association between CVT and self-regulatory behaviour, which promotes social bonds. More specifically, we present data from an ecological momentary assessment study on the association of CVT with anger regulation. For 28 days following assessment CVT predicted making a concession as a reaction to anger caused by others. Furthermore, CVT was higher in participants who reported no anger episodes compared to those who reported at least one anger episode. Additionally, CVT was positively associated with reported episodes of anger. Results are in line with the polyvagal theory, a biobehavioural model that proposes a social engagement system, that supports dynamic changes in vagal innervations in response to situational demands, resulting in the active regulation of arousal to support adaptive social behaviour.

Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis

Short-term psychological stress is associated with an immediate physiological response and may be associated with a transiently higher risk of cardiovascular events. The aim of this study was to determine whether brief episodes of anger trigger the onset of acute myocardial infarction (MI), acute coronary syndromes (ACS), ischaemic and haemorrhagic stroke, and ventricular arrhythmia. We performed a systematic review of studies evaluating whether outbursts of anger are associated with the short-term risk of heart attacks, strokes, and disturbances in cardiac rhythm that occur in everyday life. We performed a literature search of the CINAHL, Embase, PubMed, and PsycINFO databases from January 1966 to June 2013 and reviewed the reference lists of retrieved articles and included meeting abstracts and unpublished results from experts in the field. Incidence rate ratios and 95% confidence intervals were calculated with inverse-variance-weighted random-effect models. The systematic review included nine independent case-crossover studies of anger outbursts and MI/ACS (four studies), ischaemic stroke (two studies), ruptured intracranial aneurysm (one study), and ventricular arrhythmia (two studies). There was evidence of substantial heterogeneity between the studies (I(2) = 92.5% for MI/ACS and 89.8% for ischaemic stroke). Despite the heterogeneity, all studies found that, compared with other times, there was a higher rate of cardiovascular events in the 2h following outbursts of anger. There is a higher risk of cardiovascular events shortly after outbursts of anger.

Multiple sclerosis is associated with high trait anger: A case–control study

IntroductionIn recent years there has been a focus on health-related quality of life in multiple sclerosis (MS) and in particular the importance of non-motor problems such as fatigue, pain, depression, anxiety, and cognitive disorders. However, little attention has been focused on other negative emotions, such as anger. Our purpose was to evaluate whether trait anger (a predisposition to experience frequent and intense episodes of anger over time) is different between persons with and without MS after controlling for depression, anxiety, and other socio-demographic variables. Methods157 consecutive MS patients were enrolled in the study and compared to eighty age, gender, and education-matched healthy controls. Participants were administered affective trait measures (Beck Depression Inventory, Beck Anxiety Inventory) and the trait anger measure (the Spanish adapted version of the State–Trait Anger Expression Inventory-2 [STAXI-2]). ResultsMS patients had significantly higher scores on anger intensity (state anger) and trait anger than did controls. They also had a trend to experience direct anger toward other persons or objects in the environment (higher anger expression-out score) and to hold in or suppress angry feelings (higher anger expression-in score). However, in a regression analysis that adjusted for different demographic and clinical variables, we found that diagnosis category (MS patient vs. control) was associated with none of the highest quartiles of STAXI-2 scores, except for the Trait Anger scale (odds ratios between 2.35 and 3.50). ConclusionsThe present study provides further evidence that MS is independently associated with high trait anger.

A test of Spielberger’s state-trait theory of anger with adolescents: Five hypotheses.

Spielberger's state-trait theory of anger was investigated in adolescents (n = 201, ages 10-18, 53% African American, 47% European American, 48% female) using Deffenbacher's five hypotheses formulated to test the theory in adults. Self-reported experience, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to anger provoking imagery scripts found strong support for the application of this theory to adolescents. Compared with the low trait anger (LTA) group, adolescents with high trait anger (HTA) produced increased HR, SBP, and DBP, and greater self-report of anger to anger imagery (intensity hypothesis) but not greater self-report or cardiovascular reactivity to fear or joy imagery (discrimination hypothesis). The HTA group also reported greater frequency and duration of anger episodes and had longer recovery of SBP response to anger (elicitation hypothesis). The HTA group was more likely to report negative health, social, and academic outcomes (consequence hypothesis). Adolescents with high hostility reported more maladaptive coping with anger, with higher anger-in and anger-out than adolescents with low hostility (negative expression hypothesis). The data on all five hypotheses supported the notion that trait anger is firmly entrenched by the period of adolescence, with few developmental differences noted from the adult literature.

The Relation between Appraised Mismatch and the Duration of Negative Emotions: Evidence for Universality

Emotions are processes that unfold over time. As a consequence, a better understanding of emotions can be reached only when their time–related characteristics can be assessed and interpreted adequately. A central aspect in this regard is the duration of emotional experience. Previous studies have shown that an emotional experience can last anywhere from a couple of seconds up to several hours or longer. In this article, we examine to what extent specific appraisals of the eliciting event may account for variability in emotion duration and to what degree appraisal–duration relations are universal or culture specific. Participants in 37 countries were asked to recollect emotional episodes of fear, anger, sadness, disgust, shame and guilt. Subsequently, they were asked to report the duration of these episodes and to answer a number of questions regarding their appraisal of the emotion–eliciting event. Multi–level analyses revealed that negative emotions last especially long when the eliciting event and its consequences are perceived to be incongruent with the individual's goals, values and self–ideal, creating a mismatch. These relations are largely universal, although evidence for some limited variability across countries is found as well. Copyright © 2013 European Association of Personality Psychology

Affect regulation strategies and perceived emotional adjustment for negative and positive affect: A study on anger, sadness and joy

This study examines affect regulation and adaptive goals with regard to negative and positive emotional episodes. A sample of 355 undergraduate students were asked to recall an important past-year interpersonal episode of joy, anger, and sadness. Participants reported how they regulated mood and emotions associated with those episodes, filling in an expanded version of Larsen and Prizmic’s Measure of Affect Regulation Styles and also responded to measures of perceived attainment of adaptive goals for each emotional episode and psychological well-being. Affect regulation based on gratitude/self-reward, reappraisal, helping others, and seeking informative and emotional social support showed similarly high frequencies in all emotional episodes. Problem-directed action and planning, low withdrawal, seeking instrumental social support, reappraisal, rumination, active physiological regulation, gratitude/self-reward, acceptance/self-control and regulated emotional expression were related to perceived improvement in adaptive goals in all episodes. Seeking emotional and informative social support, spiritual activities, and humor were associated with adaptive goals in anger and joy. Suppression was dysfunctional in sadness and anger episodes, whereas isolation was only in anger episode. Distraction, wishful thinking, venting and confrontation were functional only in joy episode. Overall, these strategies were congruently associated with dispositional suppression and re-evaluation and psychological well-being. Regulation was globally higher in sadness and anger episodes, but venting and expression of humor and affection were higher in joy. Correlations between affect regulation strategies and adaptive goals were stronger in joy. Regulation of positive emotion is discussed as less intense but more successful than in the case of negative emotion. However, the core of adaptive regulation is importantly common to positive and negative affect.

Abstract P117: Episodes of Anger are Associated with a Higher Risk of Myocardial Infarction and Acute Coronary Syndrome: Systematic Review and Meta-Analysis

Introduction: Short-term psychological stress is associated with an immediate physiologic response. We assessed the hypothesis that brief episodes of anger may trigger the onset of acute myocardial infarction (MI) and other acute coronary syndromes (ACS). Methods: We performed a literature search of the CINAHL, Embase, PubMed and PsycInfo databases from January 1966 through June 2012 using the key words “anger”, “hostility”, “myocardial infarction” and “acute coronary syndrome” without restrictions. We also reviewed the reference lists of retrieved articles and spoke with authors of relevant work to identify unpublished data. We used an inverse-variance-weighted random effects model to perform a meta-analysis of all epidemiological studies that reported relative risks and 95% confidence intervals (CI) for the association between outbursts of anger and nonfatal MI or ACS. Results: The meta-analysis included four independent case-crossover studies of anger and risk of MI or ACS published between 1995 and 2007 and one unpublished report. Combined, there were 4546 MI cases (two studies) and 462 ACS cases (two studies), including 180 that experienced an episode of anger in the two hours prior to disease onset; two studies were restricted to first MI or ACS and two included first and recurrent events. All studies used the Onset Anger Scale to assess anger episodes, but the studies differed in the cutoff used to define exposure. The association between outbursts of anger and disease risk in the following two hours was 3.46 (95%CI 2.08-5.76; p&lt;0.001). The results were similar for studies of first and recurrent events and were similar for studies of MI and ACS. Conclusions: There is a higher risk of MI and ACS shortly after outbursts of anger. Some of the between-study heterogeneity may be due to regional differences in the type of anger expression and the interpretation of the questions. Further research is necessary to evaluate whether the risk is lower among people who are regularly active.

Cardiac vagal tone is associated with social engagement and self-regulation

The polyvagal theory (Porges, 2007) represents a biobehavioral model that relates autonomic functioning to self-regulation and social engagement. The aim of the two presented studies was to test the proposed association of cardiac vagal tone (CVT), assessed via resting high-frequency heart rate variability (respiratory sinus arrhythmia, RSA), with coping, emotion-regulation, and social engagement in young adults. In Study 1 (retrospective self-report), RSA was positively associated with engagement coping (situation control, response control, positive self-instructions, social-support seeking) and aspects of social well-being. In Study 2 (ecological momentary assessment), for 28 days following the initial assessment, RSA predicted less use of disengagement strategies (acceptance and avoidance) for regulating negative emotions and more use of socially adaptive emotion-regulation strategies (i.e., social-support seeking as a reaction to sadness and making a concession as a reaction to anger caused by others). Furthermore, RSA was higher in participants who reported no anger episodes compared to those who reported at least one anger episode and was positively associated with reported episodes of negative emotions. Results support the association proposed by the PVT between CVT and self-regulatory behavior, which promotes social bonds.

マインドフルネス瞑想の怒り低減効果に関する実験的検討

This study explores the impact of mindfulness meditation on anger. A meditation group (N = 37) attended 5-10 minutes of mindfulness meditation daily for a week. They were assessed with self-report scales measuring three aspects of anger (rumination, arousal, and lengthiness) before, just after, and four weeks after their one-week participation. Their scores were compared to a control group (N = 27), which was assessed at the same intervals as the meditation group. The meditation group was also asked to evaluate their current mood using the Affect Grid before and after each meditation. The results indicated that participants in the meditation group who continued meditation voluntarily after the week of their participation had decreased anger rumination scores just after and four weeks after their participation. Additionally, the pleasant score on the Affect Grid increased after meditation for almost all the participation days. These findings suggest the efficacy of mindfulness meditation on improving the tendency to ruminate about anger episodes in the medium-term to long-term, and also on improving mood in the short-term.

The Association Between Episodes of Anger and Onset of Acute Myocardial Infarction Symptoms

The Association Between Episodes of Anger and Onset of Acute Myocardial Infarction Symptoms